THE SHOULDER GIRDLE

Maribel G. Castro-Enano, M.D.

CPU College of Medicine

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 Introduction
1. Man phylogenetically follows the development of the
vertebrate species.
2. Pinching, holding and grasping are the 3 basic motor
functions of the hand.
3. The hand has a rich sensory innervation and is thus the
organ of feeling.
4. In relation to the telencephalon, the hand is also an organ
of expression. Other animals cannot do this.
5. Greek/Latin terms:
arm – brachium
elbow – cubitus
forearm - antibrachium
wrist - carpus
hand - manus 2
A. Skeletal System

1. Clavicle
- a long bone, clavius (“little key”)
- strut bone – gives a good range of motion to the
shoulder
- first bone to ossify
- the only bony connection of the upper extremity to the
axial skeleton
- attachment of muscles
- transmits force from upper extremity to the axial
skeleton
- one of the most commonly fractured bones

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2. Scapula
- a flat bone with 2 surfaces, a coastal (anterior) and a dorsal
(posterior)
- triangular in shape with 3 borders (superior, lateral and
vertebral) and 3 angles (superior, inferior and lateral)
- the lateral angle is the glenohumeral joint
- superior angle = T2, inferior angle = T7
- in the superior border is the suprascapular notch through
which some vessels pass through
- has 2 processes the coracoid and the spine (T3)
- the spine of the scapula divides it into a smaller supraspinatus
& a larger infraspinatus fossa; the 2 fossae communicate with
each other at the spinoglenoid notch

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2. Scapula cont….
- free border or crest of the spine ends superior to the shoulder
joint in a free, flattened expanded piece of bone, the acromion
- the acromion articulates with the clavicle
- on the lateral angle is a round-shaped shallow facet, the
glenoid
- the glenoid articulated with the head of the humerus , the
glenohumeral joint

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3. Humerus
- glenohumeral joint – where most of the movements of the
shoulder will occur
a. head – covered with cartilage, directed superomedially
b. anatomical neck – fibrous capsule of the joint is attached
c. lesser tubercle – points anteriorly, insertion for the subscapularis
d. greater tubercle – bulges laterally beyond the acromion; gives the shoulder
its roundness; insertion for the supraspinatus, infraspinatus & teres minor
e. surgical neck – between the head and the tubercles proximally and the
body distally; completely encircled by the circumflex humeral vessels and
partly by the axillary nerve

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3. Humerus cont…..
- between the greater and the lesser tubercles is the bicipital
groove (intertubercular groove) where the tendon of the biceps
attach
- the deltoid tuberosity in the shaft is the attachment of the
deltoid m.
- above the deltoid tuberosity is the spiral groove where the
radial nerve will course through
- into the crest of the greater tubercle the pectoralis major is
inserted
- into the crest of the lesser tubercle the teres major is inserted

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The Humerus

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Bones of the Shoulder Girdle

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B. Joints/Articulations
1. Sternoclavicular Joint
- ligaments keep the joint stable
a. thick articular disc of fibrocartilage between the joint
prevents the clavicle from being displaced medially
b. anterior and posterior sternoclavicular ligaments
c. costoclavicular ligament – ligament from the first rib to
the clavicle
d. interclavicular ligament – ligament between calvicles;
homologous to the “wishbone”
e. coracoclavicular ligament – between the coracoid process
and the clavicle; is in 2 parts: a conoid & a trapezoid
1.) prevents the scapula from being driven medially
2.) it is the mainstay of the acromioclavicular joint and, so long as it is intact,
the joint may , indeed, undergo subluxation, but the acromion cannot be driven
inferior to the clavicle
3.) suspends the scapula
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1. Sternoclavicular Joint cont….
f. coracoacromial ligament – between the coracoid process
and acromion
g. coracohumeral ligament – between the coracoid process
and the humerus
2. Acromioclavicular Joint
- a synovial joint
- strong parallel fibers form a complete capsule and a small
articular disc hangs into the cavity
1.) prevents the scapula to move vertically on the chest wall when the pectoral
girdle rises and falls
2.) permits the scapula (with the glenoid cavity) to glide forward and backward
on the clavicle and so to face directions convenient to eh head of the humerus
3.) its freedom is essential to free elevation of the limb
- vulnerable to injury in contact sports
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3. Glenohumeral Joint
- stabilized by muscles and a glenohumeral ligament
4. Scapulothoracic Articulation
- actually not a joint
- scapula is not attached to the thoracic wall but can glide and
move

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 C. Muscular System
1. The Pectoralis Muscles – pectus (chest)
a. pectoralis major
- covers almost the entire chest
- origin : it has 2 heads:
1.) clavicular – from the clavicle
2.) sternocostal – from the sternum and ribs
insertion : inserted by means of a folded aponeurosis into
the crest of the greater tubercle of the humerus (lateral lip of
the bicipital groove)
- action : adducts the humerus and rotates it medially

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2. The Superficial Extrinsic Back Muscles
a. trapezius
- origin: skull and spinous processes of the cervical
vertebrae via the ligamentum nuchae and all 12 thoracic spines
- insertion: lateral 3rd of the clavicle, acromion and crest of
the spine of the scapula, and tubercle on the inferior lip of the
crest of the spine
- action: suspensory muscles of the shoulder girdles;
square the shoulders and elevate the shoulder girdle

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b. pectoralis minor
- origin: ribs (3rd, 4th 5th )
- insertion: coracoid process
- action: stabilizes scapula in the thoracic cage

c. subclavius
- origin: rib 1
- insertion: inferior surface of middle 3rd of clavicle
- action: draws scapula medially

d. serratus anterior
- origin: outer surfaces of the the first 8 ribs
- insertion: medial border of scapula
- action: protract the scapula anteriorly
- “winged scapula” – results from paralysis of the serratus anterior
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2. The Back Muscles cont….
b. latissimus dorsi
- widest muscle of the back
- origin: by an aponeurosis (thoracolumbar fascia), from
the inferior 6 thoracic, all lumbar and sacral spines, & the outer
lip of the iliac crest, also arises from ribs 9-12
- insertion: lesser tubercle of the humerus and medial lip of
the intertubercular sulcus
- action: extends, medially rotates and adducts the
humerus; brings the outstretched arm from above the head to
behind the back

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3. The Deep Extrinsic Back Muscles
a. levator scapulae
- origin: transverse processes of the cervical vertebrae 1-4
- insertion: superior angle of scapula
- action: elevates the scapula

b. rhomboideus (minor and major)

- origin: ligamentum nuchae and the spines of cervical and
1st 4 thoracic vertebrae
- insertion: medial border of scapula
- action: retracts/depresses the shoulder

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4. The Intrinsic Muscles
a. deltoideus
- origin: lateral 3rd of the clavicle, the lateral border of the
acromion, and the whole length of the spine of the scapula
- insertion: deltoid tuberosity
- action: abducts, flexes and extends the shoulder

b. supraspinatus
- origin: supraspinatus fossa
- insertion: greater tubercle
- action: with the deltoid elevate the arm

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4. The Intrinsic Muscle cont…..
c. infraspinatus
- origin: infraspinatus fossa
- insertion: greater tubercle
- action: depress the arm

d. teres minor
- origin: lateral border of the scapula
- insertion: greater tubercle
- action: lateral rotation of the humerus

e. subscapularis
- origin: subscapular fossa (anterior surface of scapula)
- insertion: lesser tubercle
- action: medial rotation & adduction of the humerus 19
4. The Intrinsic Muscles cont…..
f. teres major
- origin: dorsum of the inferior angle of the scapula
- insertion: crest of the lesser tubercle tubercle anteriorly
- action: adducts and medially rotates arm

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Rotator Cuff Muscles
(supraspinatus, infraspinatus, teres
minor, subscapularis)
- they form a musculotendinous
rotator cuff for the shoulder joint
- a mass of tendons fused with the
lateral part of the capsule of the
shoulder joint
- all except supraspintus are rotators
of the humerus
- Protects the shoulder joint and
gives it stability by holding the
head of the glenoid cavity of the
scapula

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D. Bursae Associated with the Shoulder Joint

- Lined by synovial fluid

- Lessens friction between a muscle and a bone, or sometimes
between the skin and a bony prominence

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1. Subscapularis Bursa
- lies between the
subscapularis tendon and the
neck of the scapula
- protects the subscapularis
tendon where it passes
inferior to the root of the
coracoid process and over
the neck of the scapula
- usually communicates with
the cavity of the shoulder
joint through an opening in
its fibrous capsule

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2. Subacromial Bursa
- lies between the deltoid
muscle, supraspinatus tendon, &
the fibrous capsule of the
shoulder joint
- does not normally
communicate with the cavity of
the shoulder
- facilitates movement of the
deltoid muscle over the fibrous
capsule of the shoulder joint and
the supraspinatus tendon

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E. The Axilla

- has 4 walls (anterior, posterior, medial, lateral)

- Anterior wall: pectoralis major (pectoralis minor and
subclavius)
- Posterior wall: subscapularis, teres major, and latissimus
dorsi
- Lateral wall: the intertubercular sulcus
- Medial wall: intercostal muscles covered with serratus
anterior

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F. The Brachial Plexus

- A plexus is a network of
nerves
- Arise from the ventral rami of
C5-8, T1
a. sensory nerves go to the dorsal
root and motor nerves go to the
ventral root
b. the venral rami is a mixed nerve (
sensory and motor)
c. the dorsal rami provide for some
of the deep muscles of the back

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F. The Brachial Plexus

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G. The Vascular System
- great axillary vessels (and nerves)
- enveloped in the axillary sheath which is continuous with the
prevertebral fascia of the neck
- enter the axilla at its apex through the triangle formed by the clavicle, 1 st
rib and superior border of the scapula

- Great Arterial Trunk of the limb

- called the subclavian artery until it reaches the inferior border of the 1st rib
*Sources of Blood Supply to the Scapular Area from the Subclavian A.
1. suprascapular artery
2. transverse cervical a.
- in the axilla, it is known as the axillary artery
- in the arm, it becomes the brachial artery

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A. The Axillary Artery
- divided into 3 parts by the pectoralis minor

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Branches per Region:

1. supreme thoracic artery

2. thoracoacromial a. – large branch which sends 1 branch each
to the thorax, deltoid and acromion
lateral thoracic a. – accompanies the long thoracic n.
3. anterior humeral circumflex a.
posterior humeral circumflex a. – goes around the surgical
neck of the humerus; accompanies the axillary n.
subscapular a. – follows the inferior border of the pectoralis
minor; source of collateral circulation in case the axillary artery
becomes occluded
- sends a large branch to the dorsum of the
scapula, the circumflex scapular artery
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2. The Axillary Vein
- lies on the medial or concave side of its artery
- continuation of the basilic vein
- at the 1st rib becomes the subclavian vein
- receives tributaries corresponding to the 6 branches of the
axillary artery
- receives the 2 venae comitantes of the brachial artery and the
cepahalic vein

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3. The Axillary Lymph Nodes
- “checkpoints” which prevent the spread of infection
- arranged in several main groups
a. lateral nodes – receive lymph vessels that ascend along the medial side of
the arm and they empty into the
b. apical (infraclavicular) nodes – all the vessels of the limb drain either
directly or indirectly into this group, and it in turn drains into the subclavian
lymph trunk, which ends in the right lymph duct or (on the left) the thoracic
duct
c. pectoral (anterior) nodes - lie along the inf. border of the pectoralis minor
with the lateral thoracic vein
d. subscapular (posterior) nodes – lie along the subscapular veins
e. central nodes – lie between the layers of the fascia at the base of the axilly
or in the fat deep to it
f. deltopectoral nodes – occasional; small nodes along the cephalic vein

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The Axillary Lymph Nodes

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